The Electronic Health Record Scorecard: A Measure of Utilization and Communication Skills

As the adoption rate of electronic health records (EHRs) in the United States continues to grow, both providers and patients will need to adapt to the reality of a third actor being present during the visit encounter. The purpose of this project is to provide insight on “best” practice patterns for effective communication and efficient use of the EHR in the clinical practice setting. Through the development of a comprehensive scorecard, this project assessed current status of EHR use and communication skills among health care providers in various clinical practice settings. Anticipated benefits of this project are increased comfortability in interfacing with the EHR and increased satisfaction on the part of the provider as well as the patient. Serving as a benchmark, this assessment has the potential to help guide future health information technology development, training, and education for both students and health care providers

Creation of a Decision Support Tool for Expectant Parents Facing Threatened Periviable Delivery: Application of a User-Centered Design Approach

Background Shared decision-making (SDM) is optimal in the context of periviable delivery, where the decision to pursue life-support measures or palliation is both preference sensitive and value laden. We sought to develop a decision support tool (DST) prototype to facilitate SDM by utilizing a user-centered design research approach. Methods We convened four patient and provider advisory boards with women and their partners who had experienced a surviving or non-surviving periviable delivery, pregnant women who had not experienced a prior preterm birth, and obstetric providers. Each 2-h session involved design research activities to generate ideas and facilitate sharing of values, goals, and attitudes. Participant feedback shaped the design of three prototypes (a tablet application, family story videos, and a virtual reality experience) to be tested in a final session. Results Ninety-five individuals (48 mothers/partners; 47 providers) from two hospitals participated. Most participants agreed that the prototypes should include factual, unbiased outcomes and probabilities. Mothers and support partners also desired comprehensive explanations of delivery and care options, while providers wanted a tool to ease communication, help elicit values, and share patient experiences. Participants ultimately favored the tablet application and suggested that it include family testimonial videos. Conclusion Our results suggest that a DST that combines unbiased information and understandable outcomes with family testimonials would be meaningful for periviable SDM. User-centered design was found to be a useful method for creating a DST prototype that may lead to improved effectiveness, usability, uptake, and dissemination in the future, by leveraging the expertise of a wide range of stakeholders

Healthcare professionals' perspectives on mental health service provision : a pilot focus group study in six European countries

Background: The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment to all adults who need it. Methods: Seven focus groups were conducted with 49 health professionals (HPs), including psychologists, psychiatrists, social workers, general practitioners, and psychiatric nurses who worked in health services in Belgium, Cyprus, Greece, the Netherlands, Norway and Sweden. The focus group discussions centered on the barriers and facilitators to providing quality care to people with mild, medium, and severe mental health problems. Analyses included deductively and inductively driven coding procedures. Cross-country consensus was obtained by summarizing findings in the form of a fact sheet which was shared for triangulation by all the MentALLY partners. Results: The results converged into two overarching themes: (1) Minding the treatment gap: the availability and accessibility of Mental Health Services (MHS). The mhcGAP gap identified is composed of different elements that constitute the barriers to care, including bridging divides in care provision, obstacles in facilitating access via referrals and creating a collaborative 'chain of care'. (2) Making therapeutic practice relevant by providing a broad-spectrum of integrated and comprehensive services that value person-centered care comprised of authenticity, flexibility and congruence. Conclusions: The mhcGAP is comprised of the following barriers: a lack of funding, insufficient capacity of human resources, inaccessibility to comprehensive services and a lack of availability of relevant treatments. The facilitators to the provision of MHC include using collaborative models of primary, secondary and prevention-oriented mental healthcare. Teamwork in providing care was considered to be a more effective and efficient use of resources. HPs believe that the use of e-mental health and emerging digital technologies can enhance care provision. Facilitating access to a relevant continuum of community-based care that is responsive coordinated and in line with people's needs throughout their lives is an essential aspect of optimal care provision

An Occupation-Based Approach to Management of Concussion: Guidelines for Practice

Concussion and the cumulative effects of repetitive head trauma have become a growing health concern both in the mainstream media and in the health care community. Although symptoms of concussion are not always outwardly visible, evidence suggests that post-concussion symptoms may interfere with an individual’s ability to work, play, and participate in school. In the past, the recommendations following concussion emphasized a complete rest approach, whereas current approaches focus on a gradual engagement in functional activities shortly after the injury. Since current recommendations are focused on a gradual engagement in occupation and activity, occupational therapy may be a valuable service for individuals who have sustained concussions. However, despite the valuable role that occupational therapy may offer, there is limited literature supporting the role of occupational therapy in the management of concussion, and there are currently no clear guidelines for clinical practice. This paper will provide an overview of an occupation-based, client-centered framework for the management of concussion and specific guidelines for occupation-based assessments and interventions

Arts, Health and Well-Being across the Military Continuum

Is there an active, meaningful role for the arts and creative arts therapies in addressing this vast array of critical human readiness issues across the military continuum? In general, "readiness" is the #1 issue for the military at all times. The connection of the arts to the human dimension of readiness is key. Military leaders say we need every weapon in our arsenal to meet the many challenges we face today. However, one of the most powerful tools we have in our arsenal -- the arts -- is often under-utilized and not well understood within the military and the healthcare system. The arts and creative arts therapists are -- and have been -- a part of military tradition and missions across all branches, supporting military health services, wellness, and mission readiness, including family support. For example, the War Department ordered the use of music in rehabilitation for the war wounded in World War II. In June 1945, the Department of War issued "Technical Bulletin 187: Music in Reconditioning in American Service Convalescent and General Hospitals." This bulletin was a catalyst for the growth and development of music therapy being used as a rehabilitative service for active duty service members and veterans alike during and after WWII. Although many gaps exist in our knowledge regarding the arts in military settings, what we do know to date holds great promise for powerful outcomes for our service members, veterans, their families, and the individuals who care for them. Today, a growing number of members of the public and private sectors are eager to collaborate with military leaders to help make these outcomes a reality.Nowhere was the momentum for greater collaboration more evident than in October 2011, when the first National Summit: Arts in Healing for Warriors was held at Walter Reed National Military Medical Center (now referred to as Walter Reed Bethesda) and the National Intrepid Center of Excellence (NICoE). Rear Admiral Alton L. Stocks, Commander of Walter Reed Bethesda, hosted the National Summit, in partnership with a national planning group of military, government, and nonprofit leaders. The 2011 Summit marked the first time various branches of the military collaborated with civilian agencies to discuss how engaging with the arts provides opportunities to meet the key health issues our military faces -- from pre-deployment to deployment to homecoming.Building upon its success, a multi-year National Initiative for Arts & Health in the Military was established in 2012, with the advice and guidance of federal agency, military, nonprofit, and private sector partners (see Figure 2). The National Initiative for Arts & Health in the Military (National Initiative) represents an unprecedented military/civilian collaborative effort whose mission is to "advance the arts in health, healing, and healthcare for military service members, veterans, their families, and caregivers."Members of the National Initiative share a commitment to optimize health and wellness, with a deep understanding and awareness that the arts offer a unique and powerful doorway into healing in ways that many conventional medical approaches do not. The Initiative's goals include working across military, government, private, and nonprofit sectors to: 1. Advance the policy, practice, and quality use of arts and creativity as tools for health in the military; 2. Raise visibility, understanding, and support of arts and health in the military; and 3. Make the arts as tools for health available to all active duty military, medical staff, family members, and veterans

Curbing the HIV Epidemic by Supporting Effective Engagement in HIV Care: Recommendations for Health Plans and Health Care Purchasers

The United States is poised to dramatically reduce the scope of its HIV epidemic, but this demands increased leadership and attention from health plans and health care purchasers (including Medicaid, Medicare, marketplaces, and other private purchasers). This new amfAR report identifies changes in policy and practice in clinics, communities, and health care programs to reduce unnecessary health spending, increase the effectiveness of services, and increase the integration of services. Done right, the same steps that lead to appropriate management of care by health plans and purchasers also will help to achieve national public health goals

Occupational Therapy for Client Empowerment in End-of-Life Care

Purpose: To enable clients in end-of-life care (EOLC ) the opportunity to continue engaging in meaningful activities throughout their remaining days to increase QoL and experience a good death. Methods: To complete our Scholarly Project we conducted a literature review using PubMed, CINAHL, OTsearch, and AOTA publications search engines. We also conducted an informal information session with local hospice staff and from this information we chose model/theory to guide product development. Results: Upon completion of the literature review, we found the following problems existed in regard to utilization of Occupational Therapy in end-of-life care setting; 1) hospice care team members and clients lack knowledge of OT, 2) Volume of hospice clientele is increasing, 3) Clients and caregivers are not receiving the needed services, and 4) There is limited funding for OT services in hospice care. In order to address these problems a toolkit was created. This toolkit has four components including educational materials for both the medical professionals and the clients/caregivers; recommended assessments and evaluations which have been shown to be effective within the EOLC setting; recommended grant funding sources to provide initial funding for OT within EOLC; and an additional resources section with information related to utilization of OT services within EOLC. The intention of the toolkit is to provide an easy to use guide for Occupational Therapists who wish to become an active end-of-life care team member. Conclusion: Increasing utilization of Occupational Therapy in End-of-Life settings has been shown to empower client/family, promote a good death, decrease costs, provide a preventative approach to care in order to decrease secondary injuries and can serve as a means to balance utilization of team members by acting as a liaison between the client and the end-of-life care team. Having a toolkit available for Occupational Therapists who wish to be more active in the end-of-life care setting can provide a means for increasing referrals and utilization of OT services in order to empower the client

Multidisciplinary teams, and parents, negotiating common ground in shared-care of children with long-term conditions: A mixed methods study

Background: Limited negotiation around care decisions is believed to undermine collaborative working between parents of children with long-term conditions and professionals, but there is little evidence of how they actually negotiate their respective roles. Using chronic kidney disease as an exemplar this paper reports on a multi-method study of social interaction between multidisciplinary teams and parents as they shared clinical care. Methods. Phases 1 and 2: a telephone survey mapping multidisciplinary teams' parent-educative activities, and qualitative interviews with 112 professionals (Clinical-psychologists, Dietitians, Doctors, Nurses, Play-specialists, Pharmacists, Therapists and Social-workers) exploring their accounts of parent-teaching in the 12 British children's kidney units. Phase 3: six ethnographic case studies in two units involving observations of professional/parent interactions during shared-care, and individual interviews. We used an analytical framework based on concepts drawn from Communities of Practice and Activity Theory. Results: Professionals spoke of the challenge of explaining to each other how they are aware of parents' understanding of clinical knowledge, and described three patterns of parent-educative activity that were common across MDTs: Engaging parents in shared practice; Knowledge exchange and role negotiation, and Promoting common ground. Over time, professionals had developed a shared repertoire of tools to support their negotiations with parents that helped them accomplish common ground during the practice of shared-care. We observed mutual engagement between professionals and parents where a common understanding of the joint enterprise of clinical caring was negotiated. Conclusions: For professionals, making implicit knowledge explicit is important as it can provide them with a language through which to articulate more clearly to each other what is the basis of their intuition-based hunches about parents' support needs, and may help them to negotiate with parents and accelerate parents' learning about shared caring. Our methodology and results are potentially transferrable to shared management of other conditions. © 2013 Swallow et al.; licensee BioMed Central Ltd